title: Surgical management of sternoclavicular joint infection.
abstract: OBJECTIVE
  Sternoclavicular joint (SCJ) infections are rarely encountered and their management is not well standardised. We reviewed our experience with the management of this condition in order to evaluate the role of surgery in the management of the SCJ infection and to provide an algorithm for its treatment.
  
  
  METHODS
  It is a multicentre study in which we retrospectively reviewed the data files of the patients who were referred to us for surgical management of SCI infection.
  
  
  RESULTS
  From March 2003 to June 2009, 14 patients (12 men and two women) were treated surgically for infected SCJ. No patients were found in the paediatric age group. Mean age was 49.8 years with a range between 26 and 77 years. All patients were symptomatic. The prevalent symptom was either anterior chest wall swelling (21%) or pain (29%); while 50% of them presented with both swelling and pain. Associated risk factors were elicited in 12 patients (86%) while it could not be identified in two patients (14%). These risk factors were in the form of drug addiction in three patients, diabetes mellitus (DM) in four, chronic renal failure (CRF) in three patients and two patients had both DM and CRF. Surgical management was performed in all patients in the form of either incision and drainage in two patients (14%); or SCJ curettage in three patients (21%), while resection of the SCJ was done in nine patients (62%). Mean postoperative hospital stay period (PHS) was 8.1 days (range: 5-30 days). All of them are alive and free of symptoms in follow-up.
  
  
  CONCLUSIONS
  Surgery was found to be curative with good results for those patients with SCJ infection that did not respond to a full course of intravenous antibiotic therapy. Surgical options include incision and drainage, curettage or SCJ resection. The type of surgical procedure depends on the radiological findings, presentation, severity of the infection and intra-operative findings. In our experience, complex muscle flap reconstruction was not necessary following SCJ resection.
authors.affiliation: Thoracic Surgery Division, Sherbrooke University Medical Center, Sherbrooke, QC, Canada. walidabuarab@yahoo.com
authors.forename: Walid
authors.initials: W
authors.lastname: Abu Arab
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khadragui
authors.forename: Vincent
authors.initials: V
authors.lastname: Echavé
authors.forename: Annie
authors.initials: A
authors.lastname: Deshaies
authors.forename: Chantal
authors.initials: C
authors.lastname: Sirois
authors.forename: Marco
authors.initials: M
authors.lastname: Sirois
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome